Barriers to radiotherapy access and workflow efficiency in a resource-limited tertiary center: A real-world analysis from Bangladesh.

Abstract

e13638 Background: Bangladesh faces a rapidly increasing cancer burden, with GLOBOCAN 2022 estimating nearly 167,000 new cases annually. Despite high demand, radiotherapy (RT) infrastructure is critically inadequate; current capacity serves only ~13% of the population. National RT services are highly centralized, and many major public medical colleges lack functional linear accelerators (LINACs), relying on aging or non-operational Cobalt-60 units. This shortage forces a disproportionate patient load onto a few high-volume tertiary centers like Ahsania Mission Cancer and General Hospital (AMCGH). This study evaluates the impact of these infrastructure constraints on clinical workflow and waiting times. Methods: We conducted a retrospective observational study of 80 consecutive patients receiving external beam radiotherapy (EBRT) at AMCGH between March and June 2025. Data were extracted from electronic and manual logs to measure key workflow intervals: Referral-to-Consultation, Consultation-to-CT Simulation, and Simulation-to-First Fraction. Descriptive statistics compared outcomes between inpatients (n = 40) and outpatients (n = 40). Results: Of the 80 patients, 90% (n = 72) received curative-intent RT. Inpatients were significantly more likely to initiate radiotherapy within one month of prior treatment compared with outpatients (60% vs 22.5%, p < 0.01)). The median interval from CT simulation to treatment initiation was 1.0–1.5 months for 62.5% of outpatients (p < 0.01). Treatment interruptions occurred in 35% (n = 28) of cases, primarily attributed to mechanical machine downtime and treatment-related toxicities. However, a dedicated prioritization protocol for emergency palliative cases (10%) ensured timely initiation via reserved treatment slots. Conclusions: While integrated inpatient scheduling and emergency prioritization protocols mitigate some delays, substantial systemic gaps remain for outpatients in AMCGH. The high rate of interruptions due to machine downtime underscores the need for proactive maintenance and expanded infrastructure. Strengthening national referral pathways and decentralizing RT services are critical to reducing waiting times and improving survival outcomes in resource-constrained settings of Bangladesh.